Abdominal important stuff

Question 1

How often should you dose low-dose methotrexate?

(this is an objective)

Answer 1

Once a week

Question 2

Name three treatment options for C. diff.

(this is an objective)

Answer 2

1) Metronidazole
2) Fidaxomicin (DiFicid): macrolide approved in 2011
3) Vancomycin PO

Question 3

Antihistaminic/anticholinergics: List 2 OTC nausea/ vomiting meds in this category

Answer 3

1) Dimenhydrinate (Dramamine)
2) Meclizine (Bonine, Antivert)
-Very common to see this used for vertigo

Question 4

Antihistaminic/anticholinergics: List 1 Rx n/ v drug in this category. Give its dose

Answer 4

Rx: Scopolamine (Transderm Scop)
1.5 mg patch applied behind the ear every 72 hours

Question 5

Phenothiazines:
1) List a drug (Rx) in this category
2) Give its dose
3) What are the formulations?
4) What are the blackbox warnings?

Answer 5

1) Promethazine (Phenergan)
2) 12.5–25 mg every 4–6 h PRN
3) Tablet, liquid, IM, IV, suppositories; combination products available
4) Avoid IV adminstration due to risk of severe tissue injury (eg, gangrene)

Question 6

Phenothiazines: Give 3 drugs in this category that are options for n/v

Answer 6

Promethazine (Phenergan); Prochlorperazine and chlorpromazine are options too

Question 7

Ondansetron (Zofran):
1) What is its category?
2) What are its formulations?
3) What is the adult PO dose?
4) What are the 3 adverse effects?

Answer 7

1) Serotonin receptor antagonist
2) IV, liquid, ODT and tablet
3) Adult PO: 4 – 8mg PO up to TID; will see variations
4) Adverse effects: QT-prolongation, serotonin syndrome, headache

Question 8

1) What is the first line Tx for n/v for pregnancy? What are the doses?
2) What is it available out OTC?
3) What is it as an Rx?

Answer 8

1) Pyridoxine (10–25 mg 1–4 times daily) recommended as first-line therapy with or without doxylamine (12.5–20 mg 1–4 times daily)
2) OTC available as Vitamin B6 and Unisom 25mg
-Cut Unisom in half
3) Rx = Diclegis 10 / 10 mg

Question 9

Describe the role of smoking in UC and Crohn’s

Answer 9

1) UC: protective role; consider nicotine patch? Can you name any other diseases / disorders that benefit from nicotine?
2) CD: harmful role

Question 10

What group of IBD meds are all contraindicated with salicylate (aspirin) allergy?

Answer 10

Mesalamine derivatives

(like Sulfasalazine, Mesalamine (5-ASA), Olsalazine,
Balsalazide etc)

Question 11

Sulfasalazine: List the 3 baseline labs

Answer 11

CBC w/ platelet, LFTs and SCr

Question 12

IBD: Which route of administration of medications is more effective?

(on exam 3)

Answer 12

Combination therapy (oral and rectal) more effective than either alone

Question 13

What drug class can induce remission of IBDs?

Answer 13

Corticosteroids

Question 14

List 3 immunosuppressive agents for IBDs

Answer 14

1) Azathioprine (Imuran®)
2) Mercaptopurine (Purinethol®)
3) Methotrexate (MTX®)

Question 15

Methotrexate (for IBDs): List the baseline labs and routine labs

(he said to esp. know baseline labs)

Answer 15

1) DMARD labs (CBC w/platelets, LFTs and SCr) PLUS albumin, Hepatitis B/C studies, chest radiograph
2) DMARDs labs q 2-4 weeks for the first 3 months then q 8-12 weeks from 3-6 months , then q 12 weeks after 6 months of therapy

Question 16

1) Folic acid supplementation recommended for ALL patients on what medication?
2) What dose of folic acid?

Answer 16

1) Methotrexate
2) 1mg PO daily-ish

Question 17

Methotrexate; list:
1) 2 GI disturbances it can cause
2) One pulmonary issue it can cause

Answer 17

1) Stomatitis or diarrhea
2) Pulmonary fibrosis

Question 18

Methotrexate:
1) What medication can it increase levels of?
2) What can it do when taken w trimethoprim?

Answer 18

1) NSAIDS ↑ levels
2) ↑ bone marrow suppression

Question 19

List the 7 contraindications for methotrexate

(this is an exam question)

Answer 19

1) Pregnancy & lactation
2) Chronic liver disease
3) Immunodeficiency
4) Active infections
5) Leukopenia
6) Thrombocytopenia
7) Renal impairment (<30mL/min)
50% dose reduction for CrCL <50mL/min

Question 20

Methotrexate: What is the off-label dosing for Crohn’s?

Answer 20

25mg IM q week

Question 21

List and describe 3 antimicrobial options for IBDs

Answer 21

1) Metronidazole (Flagyl®): anaerobes
2) Ciprofloxacin: mod. gram (+) / great gram (-) / atypicals
3) Rifaximin: gram (+) and gram (-)
-Metronidazole and ciprofloxacin used in combination

Question 22

____________ must be given with MTX (methotrexate) to ↓ antibody formation

(important)

Answer 22

Infliximab

Question 23

TNF-alpha inhibitors & Integrin receptor antagonists are examples of what category?

Answer 23

Biologics

Question 24

Biologics (TNF-alpha inhibitors & Integrin receptor antagonists) have a risk of what infections?

Answer 24

1) Legionella and listeria infections
2) Opportunistic fungal infections (histoplasmosis)
3) TB

Question 25

TNF-alpha inhibitors: What are the contraindications? (test question)

Answer 25

1) Heart failure Leads to new onset and exacerbations Do NOT use with NYHA class III or IV with EF <50% 2) Malignancies (i.e., skin cancer or lymphoproliferative cancers) 3) Active hepatitis

Question 26

TNF-alpha inhibitors: What are the adverse effects? (test question)

Answer 26

MS exacerbation or MS-like symptoms Neutropenia Injection site reactions Hepatotoxicity Anaphylaxis

Question 27

Integrin receptor antagonist: Natalizumab (Tysabri®) What are 2 risks with this med?

Answer 27

1) Previously withdrawn from market due to risk of progressive multifocal leukoencephalopathy (PML) 2) Severe hepatic toxicity

Question 28

Which integrin receptor antagonist is associated with PML? (important)

Answer 28

Natalizumab (Tysabri®)

Question 29

List 2 integrin receptor antagonists [used for IBDs]

Answer 29

Natalizumab (Tysabri®) Vedolizumab (Entyvio®)

Question 30

List an interleukin agent

Answer 30

Ustekinumab (Stelara®)

Question 31

Ustekinumab (Stelara®): 1) What is the MOA? 2) What 2 things can it treat? (important)

Answer 31

1) Monoclonal antibody that targets IL-12 and IL-23 2) UC and CD

Question 32

Ustekinumab (Stelara®): 1) What are the adverse effects? 2) What are the 2 warnings?

Answer 32

1) Increased risk of infections, neurotoxicity and malignancy 2) Antibody development and decreased efficacy

Question 33

What IBD med reduces IgG, IgM, & IgA?

Answer 33

JAK inhibitor: Tofacitinib (Xeljanz®)

Question 34

Name a JAX inhibitor

Answer 34

Tofacitinib (Xeljanz®)

Question 35

Tofacitinib (Xeljanz®) (JAX inhibitor): What does it increase risk of?

Answer 35

Increased risk of thrombosis -DVT/PE/arterial thrombosis

Question 36

Tofacitinib (Xeljanz®): 1) What is it metabolized by? 2) What is a contraindication?

Answer 36

1) CYP3A4 and some CYP2C19 2) 3A4 inducers

Question 37

Antibiotics can be used for induction of what stage of IBDs?

Answer 37

Mild-moderate

Question 38

What are 3 pharmacologic monotherapies for IBDs?

Answer 38

1) Metronidazole 2) Fidaxomicin (DiFicid) – macrolide approved in 2011 3) Vancomycin PO